Our surgeon wants to report CPT code 30930 every time he does an turbinate outfracture with his submucous resections (30140). I have explained that the outfracture is included but he disagrees. I talked to a peer in another practice and he told me that I can’t report it because there is a CCI edit in place. We code according to CPT rules, not Medicare payment rules, thus I would never use that as rationale in explaining to the surgeon why a code set is reportable together or not. Can KZA help with an explanation?
Great question and thanks for reaching out to the Otolaryngology Coding Team. We checked with the team and our response follows.
In 2006, CPT revised the definition of CPT code of the turbinate codes to identify surgical procedures on the inferior turbinates only. According to a citation in the CPT Changes: An Insider’s View, “CPT codes 30130, 30140, 30801, 30802, and 30930 have been revised to clarify their widespread usage specific to the inferior turbinates and primary reporting for procedures performed for the treatment of inferior turbinate hypertrophy causing nasal airway obstruction and to eliminate frequent confusion with middle and superior turbinates when other intra-nasal surgeries (e.g., endoscopic sinus surgery) are performed.”
Additionally, codes 30801, 30802, and 30930 were revised with the removal of “separate procedure” from the descriptors. Cross-references were added in support of these revisions to indicate codes 30130 (partial or complete excision of turbinate bone) and 30140 (partial or complete submucous resection of turbinate bone), which report larger procedures for which removal of the inferior turbinates are inherent, would not be appropriately reported in conjunction with these codes.” As a result of this rule change when the codes were revised to specifically address surgery on the “inferior” turbinates, the procedures became inclusive to each other.
Finally, the CPT guidelines listed directly underneath 30930 state “(Do not report 30801, 30802, 30930 in conjunction with 30130 or 30140)”. Therefore, it is not appropriate to report 30930 with 30140 ever for procedures on the same turbinate.
Just because there is a Medicare CCI column edit of “1” doesn’t mean it is appropriate to report both codes. You must understand CPT coding rules first.